| NPI | 1609959857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WA MD00034406) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WA MD00034406) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2010-05-18 |